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In spite of the attempts made thru the CEHAP Insurance Counseling Service to help you understand the benefits that your health insurance plan offers for prosthetic services, many families discover that when an actual medical claim is filed for payment," the rules have changed".
CEHAP maintains an ongoing effort to advocate for the right of each child to benefit from the most appropriate prosthetic intervention.
Two approaches to solve this problem have yielded a better than 80% success rate in reversing "denials of coverage". Most insurance plan denials are based on a policy determination that all electronic prosthetic arms for kids are not "medically necessary", but are considered "experimental or investigational".
The first step in this dual process includes the effective use of practice methods founded on evidence-based-prosthetics, to develope and document clinical results that substantiate the medical necessity of the recommended prosthetic services.
The second step involves the unrelenting use of each insurance plan's internal and external appeal processes, sometimes to the 3rd and 4th level.
This combined strategy requires a considerable effort and may postpone the delivery of care for several months. However, the near term benefits to your child and the long range effects that these "precedent-setting decisions" establish for future child amputees with upper extremity amputations or congenital limb differences, make it all worthwhile.
For more information click
on HOW TO CONTACT US
OR CALL (TOLL FREE) (866) MYO-ARMS (866) 696-2767
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